Claims Examiner II - Workers' Compensation - (US-WA-Seattle)

Minimum Education: Tech School
Job Type: Full Time
Jobcode: 1741849
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Claims Examiner II - Workers' Compensation

CLAIM YOUR FUTURE AS A GREAT PERFORMER!

Continuing double-digit revenue growth rates and progressive employment practices make Sedgwick Claims Management Services the place where great people can do great things for clients while maximizing their career possibilities. We have earned a reputation for innovation, quality, sustained growth, financial stability and a colleague-friendly work environment. We are proud to have been voted the Best TPA in America for 2005 and 2006, and the first and only Third Party Administrator to receive the coveted Employer of Choice designation. Come be a part of our team and "Claim Your Future."

PRIMARY PURPOSE:
To analyze mid and higher-level workers compensation, general liability or disability claims to determine benefits due; to ensure ongoing adjudication of claims within company standards and industry best practices; and to manage subrogation of claims and negotiate settlements.

ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Processes general liability claims by gathering information to determine liability exposure, assigns reserve values to claims, making claims payments as necessary and settling claims up to designated authority level.
Processes workers compensation claims determining compensability and benefits due on long term indemnity claims, monitors reserve accuracy, and files necessary documentation with state agency.
Develops and manages workers compensation claims' action plans to resolution, coordinates return-to-work efforts, and approves claim payments.
Approves and processes assigned disability claims, determines benefits due, and manages action plan pursuant to the disability claim or client contract.
Manages subrogation of claims and negotiates settlements.
Communicates claim action/processing with claimant and client.
Ensures claim files are properly documented and claims coding is correct.
Maintains professional client relationships.
Maintains a quality assurance program to support the total performance management initiative and the consistent delivery of quality claims service.

QUALIFICATIONS
Education & Licensing
Baccalaureate degree from an accredited college or university preferred. Licenses as required.

Experience
Two (2) years of claims management experience or successful completion of Claims Examiner II training required.


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http://www.applyhr.com/14499460